HomeMy WebLinkAboutMortgage_Guetlinge`° rt�'� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i+ "` :': FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S �y Slate Form 43709 (R4 / 70-01)
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PreSCribeO by Departnent ol Local Govemmeni Finance
IN �eRUC TION Sson or by mail with fhe County Auditor of the county �vhe2 the property is located. �� �e Ma� �
Filing Dates: 1) Real Property: During the 12 months before May 11 ollhe year the deducfion is to be effectiv .
2) Mo6ile Homes assessed under IC 6-1.1-7: Belween January 15 and March 31 0/ the year th��ul�o� i� el/ective.
See reverse side !o� additional instiuctions and quali�cations. %' �,
Applicant
March 1,
Ii no, what is
contract
of real property as of
year
! her exact share of interest?
If name on record is different than that of
Key number ! legal description
Record number � �
� O � ^ O � � � �^M Page number � � ��
w
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curr t year ownef? ❑ Yes ❑ No
��O �
If owned with someone other than spouse, indicate with whom.
below:
�me of mortgagee or contract seiler �.^ /
J
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st�eet, city, state,
Does applicant own property in any olher I If yes, what couniy? What Taxing Dislrid?
county in Indiana?
Deduction approved in the amouni ot:
20 20 20
Q e � it—
Signature
COUNTY AUDITOR
I 20 �
�J
County Auditor
20
Is the property in question:
❑ Real PropeAy ❑ Mobile Hane pC 61.1
9,.5��0� �4%
Has this deduction been requested on
property for current year?� Yes❑ No
20 d�
Date
�
�
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authurized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person